Understanding
Accident
and
Emergency Departments and when
to use them
This leaflet is intended for patients and the general
public to help them understand what Accident and
Emergency Departments (A&E) are, when to use
them and some of the alternative sources of help
available.
What are A&E Departments are?
A&E departments, sometimes called casualty or
emergency departments, are hospital units where
the public can attend without appointment, for
accidents, emergencies and other very urgent
medical conditions which may require the facilities
and expertise of highly skilled hospital teams.
Examples where it is right and appropriate to attend
A&E without delay include:

Major injuries such as injuries from road
traffic accidents

Falls from a considerable height

Major head injuries

Collapse

Severe breathing difficulty

Severe chest pain

Severe haemorrhage

Poisoning

Extensive burns
There is absolutely no doubt that someone who is
seriously injured or collapsed needs to attend A&E
and may well also require pre-hospital care from the
Ambulance Service.
What facilities and skills are there at
A&E?
A&E departments are staffed by nurses, nurse
practitioners (who can see and treat some cases
independently), junior doctors and increasingly by
more senior doctors. These staff are supported by
clerks, porters, radiographers, plaster technicians
and other staff. Most doctors who later go on to
work in other areas will at some time have had
experience of working in an A&E department.
On arrival at A&E most patients will be “triaged”.
This means that they will be seen by a member of
staff who will briefly assess the problem and will
decide the degree of urgency.
Critically ill patients will be attended in a
designated area where a team of highly skilled
doctors and nurses will work together to deliver
life-saving treatment. Less serious cases may be
attended by a nurse practitioner or junior doctor
who will assess and treat the problem. Some
patients require special investigations such as X
Rays, Scans, ECGs. Some will require emergency
drugs, dressings, plaster casts, intravenous fluids
or blood transfusion.
Some patients will be admitted to the hospital for
further treatment, whilst others may be followed
up as an “out patient”, though most are
discharged to the GP.
What sorts of conditions are
appropriate for A&E departments?
not
Unfortunately many people attend A&E with very
minor problems. This makes it difficult for A&E
staff to deal with the volume of cases, involves
delays for patients and incurs considerable costs.
The following are example of minor problems for
which A&E attendance is not appropriate.
Generally, if the person is unwell, but alert and
speaking without impaired consciousness or
severe breathing difficulty, then they do not need
to attend.

Flu-like illnesses, coughs, earache, back
ache

Sore throats

Minor breathlessness or wheezing

Abdominal pain (unless extreme or
associated with collapse)

Urinary difficulties (unless completely
unable to pass water)

Vaginal bleeding (unless very heavy and
associated with faintness)

Rashes
(unless
it
appears
like
spontaneous bleeding under the skin or
the person is very unwell)

Backache

Diarrhoea and vomiting




Simple bites and stings
Social problems
Emergency contraception
Dental problems (except major trauma)
Such conditions can generally be safely managed by
your GP, practice nurse and sometimes by the
individual themselves.
Disadvantages to attending A&E if not
essential
People who attend A&E with non-serious conditions
risk overloading the services that are primarily
intended for delivering emergency care for people
who are critically ill. We should all remember that
“one day it could be us” who need that life-saving
care. They are also likely to wait quite a long time for
treatment, though due to the recently introduced 4
hour A&E targets, this is improving.
Most GPs believe that people who attend hospital
A&E departments are likely to be seen by junior staff,
are more likely to undergo non-essential tests and
are more likely to end up being admitted to hospital
than if they are seen by experienced doctors such as
GPs.
How much does it cost?
Following recent changes to NHS funding
arrangements, each attendance at A&E is now
individually charged to the Primary Care Trust and
ultimately to the patient’s general practice.
Each attendance at A&E is charged at a standard
rate. For more complex cases a higher charge is
levied. Costs of admission or outpatient follow up are
added to these costs. The current tariffs are:
A&E standard £61
A&E higher
£93
MIU
£35
So, a person attending A&E with ‘flu, a sore throat,
diarrhoea or an insect bite costs a minimum of £61.
Some will say “I pay my taxes and it was urgent to
me”, but we all have a responsibility to make best
use of limited resources. Money spent on nonessential A&E attendance means less money to
spend on other services or developing new ones.
What alternatives are there to attending
A&E?





General Practices provide comprehensive
services between 8am and 6.30pm Monday
to Friday. All practices can provide same
day appointments for urgent problems.
Some practices have nurse practitioners or
practice nurses who can see and advise
patients themselves. Most GPs can arrange
to telephone a patient to offer advice if
requested to do so.
When practices are closed during the
evenings, weekends and bank holidays,
there is an Out of Hours Service for
urgent medical problems which cannot wait
until the person’s own practice is open. If
you do not have the number of the OOH
service, just telephone your usual surgery
number and you will either be transferred
or will hear a message giving you the
number to ring.
The Orchard Medical Centre –
Kingswood has appointments available
even if you are not registered with them.
Contact 0117 9805100 and you can
arrange to be seen by a doctor or nurse.
Orchard Medical Centre, Macdonald Walk,
Bristol BS15 8NJ (Nr Somerfield). Open 7
days a week from 8.00am to 8.00pm.
There are additional NHS Walk in Centres
in Knowle and Central Bristol, which can
treat minor illnesses.
Central Bristol: 33 Board Street, Bristol
BS1 2EZ. Open Monday to Saturday from
8.00am to 8.00pm; Sundays and Bank
Holidays open from 10am to 6pm.
Knowle: West Health Park, Downton road,
Bristol BS4 1WH open 7 days a week 9am –
9pm
Minor Injuries Unit at Yate West
Gate Centre
Yate Minor Injury Unit will be open Monday
– Friday 8am – 7:30 pm, Saturday and
Sunday 10am – 2pm from 22nd June 2010.
It is located at West Walk,
Shopping Centre, Yate BS37 4AX.



Yate
Minor Injuries Unit Southmead
Hospital
Southmead Hospital has a designated
Minor Injuries Unit (MIU) open 9am until
9pm seven days a week. The Minor
Injuries Unit is located at the Monk Park
entrance, Bristol BS10 5NB.
Both Minor Injury Units are staffed by
highly trained nurses to deal with minor
injuries such as wounds, sprains, minor
fractures and minor head injuries where
the patient does not need the facilities of
a major A&E department and parking is
available.
Most pharmacies can advise on minor
illness and can provide medication to
help you manage your condition
yourself. Pharmacies can also provide
emergency contraception and some
pharmacies are open extended hours.
NHS
Direct
(0845
4647)
or
www.nhsdirect.nhs.uk
can
provide
information on what to do if you are not
sure, as well as information about local
services such as pharmacy opening
times and emergency dental care.
Understanding
Accident and
Emergency
departments and
when to use them.